Application for Insurance Agent Certificate of Authority

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Personal information on this application form is collected under Sections 345, 346, and 347 of the Insurance Act, as it relates directly to and is necessary for the purposes of applying for a certificate of authority to act as an insurance agent.  If you have any questions about this collection of personal information, you may contact the Superintendent of Insurance, Financial and Consumer Services Division, 902-368-4550.

For example C1B 0X1 or 12345
For example 902-555-5555